CHIEF OPERATING OFFICER (COO) – HEALTHCARE TPA, SW Region
Our client is a rapidly growing healthcare benefits administration organization focused on serving self-funded employers, health plans, brokers, and members through innovative cost-containment, healthcare navigation, and third-party administration solutions.
The organization has established a strong reputation for delivering high-touch service, operational excellence, and measurable healthcare cost savings for employer groups across the United States. The company is entering its next phase of growth and seeks a transformational operations executive to scale infrastructure, improve performance, and support continued expansion.
The organization operates in an entrepreneurial, performance-driven environment where leadership visibility is high and executives have a direct impact on business strategy, client outcomes, profitability, and long-term growth.
Position Summary
The Chief Operating Officer (COO) will serve as the senior operational leader for the Third-Party Administrator (TPA) division and a key member of the executive leadership team.
Reporting directly to executive leadership, the COO will oversee all core TPA operations including:
* Claims Administration
* Member Services
* Eligibility & Enrollment
* Client Implementation
* Account Management / Client Service
* Stop Loss Operations
* Vendor Management
* Operational Technology & Process Improvement
The COO will be responsible for establishing scalable operating models, improving operational performance, driving service excellence, optimizing profitability, and developing leadership teams capable of supporting significant future growth.
This executive will play a critical role in transforming operations while maintaining exceptional service standards for self-funded employer clients and members.
Key Responsibilities
- Strategic Leadership
* Partner with executive leadership to define and execute long-term business strategy.
* Translate growth objectives into scalable operational plans.
* Build organizational infrastructure capable of supporting future expansion.
* Establish operational discipline, accountability, and performance management throughout the organization.
- Claims Operations
* Lead all claims administration functions.
* Improve adjudication accuracy, turnaround times, productivity, and quality metrics.
* Implement best practices for workflow management and inventory control.
* Ensure audit readiness and operational compliance.
- Member Services & Client Experience
* Enhance member service responsiveness and satisfaction.
* Improve client retention through operational excellence.
* Support key client relationships and executive-level escalations.
* Establish measurable service standards and performance benchmarks.
- Stop Loss Operations
* Oversee stop loss administration and carrier relationships.
* Monitor large claims activity and reimbursement processes.
* Evaluate financial exposure and risk management strategies.
* Support renewal planning and stop loss program optimization.
- Financial & Operational Management
* Manage operational budgets and workforce planning.
* Drive profitability through operational efficiencies.
* Utilize data analytics and performance metrics to guide decision-making.
* Develop forecasting models and productivity standards.
- Process Improvement & Technology
* Identify operational inefficiencies and process gaps.
* Lead automation and workflow improvement initiatives.
* Partner with technology leadership on system enhancements.
* Improve utilization of claims systems, eligibility platforms, reporting tools, and dashboards.
- Compliance & Risk Management
* Ensure compliance with:
* ERISA
* HIPAA
* ACA
* COBRA
* State TPA regulations
* Claims appeals requirements
- Leadership & Culture
* Build, mentor, and develop a high-performing leadership team.
* Create a culture of accountability, service excellence, and continuous improvement.
* Foster collaboration across operational and client-facing departments.
Candidate Profile
The ideal candidate is a proven healthcare operations executive with significant experience leading a healthcare TPA, self-funded health plan administrator, payer operation, or benefits administration organization.
- 12+ years of healthcare operations leadership experience.
- 5+ years leading multiple operational departments within a TPA, payer, or benefits administration environment.
- Deep expertise in:
* Claims Operations
* Member Services
* Eligibility Administration
* Client Implementations
* Stop Loss Administration
* Vendor Management
- Demonstrated success improving:
* Scalability
* Efficiency
* Service quality
* Process consistency
* Financial performance
Preferred Background
* COO
* SVP Operations
* VP Operations
* Head of Operations
Experience supporting:
* Self-funded employer health plans
* Multi-state operations
* High-volume claims environments
* Operational transformation initiatives
* System implementations
Compensation:
- 225,000-250,000 salary target DOE
- Plus, Bonus – target is 30% of base salary
- Benefits/Retirement Plans
For additional information contact:
Dan Rogan
President
The Rogan Group, Inc.
Risk & Insurance Management Recruiting
714-225-2244 cell
800-440-0082 direct